Provider Demographics
NPI:1154637486
Name:PSYCHIATRIC CONSULTANTS LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-320-7895
Mailing Address - Street 1:18 INDEPENDENCE LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6242
Mailing Address - Country:US
Mailing Address - Phone:508-329-7895
Mailing Address - Fax:508-872-6330
Practice Address - Street 1:18 INDEPENDENCE LN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6242
Practice Address - Country:US
Practice Address - Phone:508-329-7895
Practice Address - Fax:508-872-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47643103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB99333Medicaid